Cost-effectiveness analysis of the Ottawa Ankle Rules

Ann Emerg Med. 1995 Oct;26(4):422-8. doi: 10.1016/s0196-0644(95)70108-7.


Study objective: To conduct an incremental cost-effectiveness analysis of implementation of the Ottawa Ankle Rules in emergency departments in the United States and Canada.

Design: A decision analytic approach to technology assessment. Clinical decision rules that allow physicians to be more selective in their use of radiography were compared with current practice in a decision analytic model.

Setting: A university hospital adult ED.

Participants: ED physicians instructed in the use of the Ottawa Ankle Rules for adult patients with ankle injury.

Results: Radiography, waiting time, lost productivity, and medicolegal costs were calculated. In the United States, the savings varied between US$614,226 and US$3,145,910 per 100,000 patients, depending on the charge rate for radiography. In Ontario, Canada, the total savings were CAN$730,145 per 100,000 patients. One- and two-way sensitivity analyses that varied the rate of missed fractures, cost of radiography, probability of lawsuits, and cost of lawsuits did not change the results substantially.

Conclusion: Implementation of the Ottawa Ankle Rules would result in significant savings of health care dollars despite the cost of missed fractures including litigation costs.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Ankle Injuries / diagnostic imaging*
  • Ankle Injuries / economics
  • Canada
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Decision Trees
  • Emergency Service, Hospital / economics*
  • Emergency Service, Hospital / standards
  • Fractures, Bone / diagnostic imaging
  • Humans
  • Probability
  • Radiography
  • Sensitivity and Specificity
  • United States